> I've now read through hundreds of medical abstracts,many
> directly contradicting each other, and the one firm
> conclusion I have is that most of these so called studies
> are ridiculously small and don’t control for bias. The
> sample sizes are tiny, e.g. 64 or 156. To their credit,
> most of the studies are labeled as such and marked “Level
> of evidence III” or “Level IV”. Level V is just expert
> opinion and each level moves up a little from there.
> Ideally they should all be level I or II.
> It is even more amazing when you consider that consumer
> companies wouldn’t think of coming out with a new flavor of
> cream cheese or Jell-O without thousands tested in a sample
> size and with factors controlled for
> demographics,seasonality, price etc. Granted, these
> situations are easier to set up and measure with
> supermarket scanners than measuring surgical outcome and
> follow up since you need cooperation from patients but the
> point remains. The studies may be contradictory because
> they are small and don’t control for other factors.
> I’m starting to think that one of the factors not
> controlled for in these studies is skill of the surgeon,
> and may be the most important.
> I’d be interested in how others rank this in comparison to
> some of the following factors for a successful outcome:
> Skill of surgeon vs graft type, prehap, rehab, physical
> therapist, age of patient, activity level of patient and
> previous injury?
Everyone who reads my posts must first click on my username and read my profile.
I have been reading these studies for over 30 years and agree with you, but have found that some things keep coming through that have and have not what to do with surgical/rehab skill.
Early complications such as flexion contracture, missed placed graft have all to do with surgical skill and are rare to nearly nonexistant in skilled hands.
Late complications like attritional rupture of an allograft have nothing to do with the installation.
Hope this helps
